Genetic polymorphisms of the cytochrome P450 2C19 ( CYP2C19) gene are relatively common among Asians, including the Japanese population, 6Īnd could be a major concern for monotherapy with clopidogrel. This strategy may have a big effect on daily practice, as the prevalence of high bleeding risk (HBR) in all PCI cases is reported to be at approximately 50%. Therefore, the aspirin (acetylsalicylic acid )-off strategy is currently in the spotlight as a strategy to reduce bleeding complications without increasing ischemic risk. A recent network meta-analysis showed that both short- (12 months) DAPT however, these strategies had a higher risk of myocardial infarction (MI) and stent thrombosis compared with extended-term DAPT. 3Ī way to prevent bleeding complications is to shorten the DAPT duration after percutaneous coronary intervention (PCI). The beneficial effect of new-generation drug-eluting stents on the outcomes of patients with ischemic heart disease has led to substantial changes in the strategy of OMT after revascularization.ĭual antiplatelet therapy (DAPT) has been essential to prevent stent thrombosis, but bleeding complications have been reported with long-term DAPT use. In addition to lifestyle modifications, good control of risk factors and optimal antithrombotic therapy are key components of OMT. Recent trials have highlighted the importance of optimal medical therapy (OMT) for the management of ischemic heart disease, irrespective of the revascularization strategy. Prasugrel SAPT may reduce BARC 2, 3, or 5 bleeding, without increasing MACCE, in Japanese patients with HBR. There was no significant difference in major adverse cardiac and cerebrovascular events (MACCE) from 1 to 12 months after PCI (HR, 0.93 95% CI, 0.63–1.37 P=0.696) and at 12 months after PCI (HR, 0.85 95% CI, 0.61–1.19 P=0.348) between the groups. The adjusted cumulative incidence of Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding from 1 to 12 months after PCI (primary endpoint) was 2.8% (95% confidence interval, 1.9–4.2) and 4.1% (95% CI, 3.3–5.1), respectively (hazard ratio, 0.69 95% CI, 0.45–1.06 P=0.090). dual antiplatelet therapy (DAPT) in Japanese percutaneous coronary intervention (PCI) patients with high bleeding risk (HBR) are currently unknown.ĭata from 1,173 SAPT and 2,535 DAPT patients from the PENDULUM mono and PENDULUM registry studies (respective median DAPT durations: 108 vs. Outcomes with prasugrel single antiplatelet therapy (SAPT) vs. ĭepartment of Medical Statistics, School of Medicine, Toho University ĭivision of Cardiology & Catheterization Laboratories, Shonan Kamakura General Hospital ĭata Intelligence Department, Daiichi Sankyo Co., Ltd. Medical Science Department, Daiichi Sankyo Co., Ltd. Division of Cardiovascular Medicine, Toho University Ohashi Medical Center ĭepartment of Cardiology, Kurashiki Central Hospital ĭivision of Cardiology, Saiseikai Kumamoto Hospital ĭepartment of Cardiovascular Medicine, Shiga University of Medical Science ĭivision of Cardiology, Osaka Saiseikai Nakatsu Hospital Ĭardiovascular Medicine Center, Fukuoka Sanno Hospital ĭivision of Cardiology, Department of Internal Medicine, Teikyo University Hospital ĭivision of Cardiology, Mitsui Memorial Hospital ĭepartment of Cardiovascular Medicine, Wakayama Medical University ĭivision of Cardiology, Department of Medicine, Showa University School of Medicine ĭepartment of Cardiovascular Medicine, Fukuoka Kinen Hospital ĭepartment of Cardiology, Osaka Police Hospital ĭepartment of Cardiology, Kawasaki Medical School

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